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NPI Code Detail

MEDICARE: MARYKAY ELIZABETH PHILLIPS

MEDICARE: MARYKAY ELIZABETH PHILLIPS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric HospitalOK

General Provider Information

NPI Number : 1790636405
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYKAY ELIZABETH PHILLIPS
Provider Business Mailing Address
First Line : 27 E ROSS AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-6423
Country : US
Telephone Number : 539-265-8264
Fax Number :
Provider Business Practice Location Address
First Line : 27 E ROSS AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-6423
Country : US
Telephone Number : 539-265-8264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2026
Last Update Date : 02/07/2026

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Directions to “ MARYKAY ELIZABETH PHILLIPS ” Practice Location

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